CPT 71260Radiology

Ct thorax dx c+

CPT code 71260 covers a CT scan of the chest performed with contrast dye (injected into a vein) to create detailed cross-sectional images of the lungs, heart, blood vessels, and surrounding structures.

Showing rates for

National Average

Base Medicare rate

$164.32

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

1.16

PE RVU (NF)

3.85

MP RVU

0.07

Total RVU

5.08

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Split billing correctly between facility and professional components - facilities bill global code or TC modifier; radiologists bill 26 modifier for interpretation
Impact: Prevents duplicate billing denials and ensures proper payment distribution; TC component represents approximately $106.81 and professional component $57.51 of total $164.32
Document contrast type, dosage, route, and administration time in radiology report or procedure note to support medical necessity
Impact: Reduces denial risk by 40-60%; contrast documentation is primary audit target for differentiating 71260 from 71250
Verify pre-authorization requirements before study - most commercial payers require prior auth for CT imaging within 24-48 hours
Impact: Prevents authorization denials that can result in 100% payment loss; emergency studies may have retrospective authorization options
Link appropriate ICD-10 diagnosis codes that justify contrast use - pulmonary embolism (I26.x), lung mass (R91.1), chest pain (R07.x) typically support medical necessity
Impact: Improves first-pass claim acceptance rate by 30-45%; vague or unsupported diagnoses trigger medical necessity denials
Do not bill 71260 with 71250 (without contrast) or 71270 (without and with contrast) for same session - these are mutually exclusive
Impact: Prevents bundling/unbundling denials and potential fraud allegations; bill only the highest level study performed (71270 if both without and with contrast)
Bill same-day contrast injection separately only if performed by different provider and documented separately - typically bundled into CT payment

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 71260 in 2025?

The 2025 Medicare national average payment for CPT 71260 is $164.32 for both facility and non-facility settings. This is based on 5.08 total RVUs (1.16 work RVU, 3.85 practice expense RVU, 0.07 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality.

What is the difference between CPT 71250, 71260, and 71270?

CPT 71250 is CT chest without contrast, 71260 is CT chest with contrast only, and 71270 is CT chest without contrast followed by with contrast. These codes are mutually exclusive - bill only one per session. 71270 represents the highest level study when both non-contrast and contrast phases are performed and should be billed instead of 71250 or 71260 when both are done.

Does CPT 71260 require prior authorization?

Prior authorization requirements vary by payer. Medicare traditional does not require pre-auth but does participate in the Appropriate Use Criteria program requiring consultation of clinical decision support. Most Medicare Advantage and commercial plans require prior authorization for non-emergent CT studies. Emergency department studies typically have different authorization pathways. Always verify with specific payer before scheduling.

Can I bill for the contrast injection separately with CPT 71260?

No, contrast administration is included in the CT procedure payment and should not be billed separately when performed by the same provider on the same date. Codes like 96374 (IV push) are bundled into 71260 per NCCI edits. Separate billing constitutes unbundling and can result in denials and audit risk.

What diagnosis codes support medical necessity for 71260?

Common supporting diagnoses include pulmonary embolism (I26.x), hemoptysis (R04.2), lung mass or nodule (R91.1), chest pain (R07.x), dyspnea (R06.x), lung cancer (C34.x), mediastinal mass (D15.2, D38.3), aortic disease (I71.x), and lymphadenopathy (R59.x). The diagnosis must justify the need for contrast enhancement specifically, not just CT imaging in general.

How do I bill 71260 for professional component only?

Append modifier 26 to CPT 71260 when billing only for physician interpretation and report without the technical component. This is standard for radiologists interpreting studies performed at hospitals or imaging centers. The professional component represents approximately 35% of total payment. Bill as 71260-26 on the claim.

What are the RVUs for CPT code 71260 in 2025?

CPT 71260 has 5.08 total RVUs in 2025, composed of 1.16 work RVUs, 3.85 practice expense RVUs (both facility and non-facility), and 0.07 malpractice RVUs. These values are from the CMS Physician Fee Schedule released December 23, 2024, and are used to calculate the Medicare payment of $164.32 when multiplied by the conversion factor of 32.3465.